Provider Demographics
NPI:1912390915
Name:SISNEROS, RONNIE M (COTA/L)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:M
Last Name:SISNEROS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 SIERRA PRADO CT
Mailing Address - Street 2:3534 SIERRA PRADO CT
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-0722
Mailing Address - Country:US
Mailing Address - Phone:575-636-3684
Mailing Address - Fax:
Practice Address - Street 1:3534 SIERRA PRADO CT
Practice Address - Street 2:3534 SIERRA PRADO CT
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-0722
Practice Address - Country:US
Practice Address - Phone:575-636-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2335175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath